Overground Walking Program With Robotic Exoskeleton in Long-term Manual Wheelchair Users With Spinal Cord Injury

BACKGROUND In wheelchair users with a chronic spinal cord injury (WU<sub>SCI</sub>), prolonged nonactive sitting time and reduced physical activity—typically linked to this mode of mobility—contribute to the development or exacerbation of cardiorespiratory, musculoskeletal, and endocrine-metabolic health complications that are often linked to increased risks of chronic pain or psychological morbidity. Limited evidence suggests that engaging in a walking program with a wearable robotic exoskeleton may be a promising physical activity intervention to counter these detrimental health effects. OBJECTIVE This study’s overall goals are as follows: (1) to determine the effects of a 16-week wearable robotic exoskeleton–assisted walking program on organic systems, functional capacities, and multifaceted psychosocial factors and (2) to determine self-reported satisfaction and perspectives with regard to the intervention and the device. METHODS A total of 20 WU<sub>SCI</sub>, who have had their injuries for more than 18 months, will complete an overground wearable robotic exoskeleton–assisted walking program (34 sessions; 60 min/session) supervised by a physiotherapist over a 16-week period (one to three sessions/week). Data will be collected 1 month prior to the program, at the beginning, and at the end as well as 2 months after completing the program. Assessments will characterize sociodemographic characteristics; anthropometric parameters; sensorimotor impairments; pain; lower extremity range of motion and spasticity; wheelchair abilities; cardiorespiratory fitness; upper extremity strength; bone architecture and mineral density at the femur, tibia, and radius; total and regional body composition; health-related quality of life; and psychological health. Interviews and an online questionnaire will be conducted to measure users’ satisfaction levels and perspectives at the end of the program. Differences across measurement times will be verified using appropriate parametric or nonparametric analyses of variance for repeated measures. RESULTS This study is currently underway with active recruitment in Montréal, Québec, Canada. Results are expected in the spring of 2021. CONCLUSIONS The results from this study will be essential to guide the development, implementation, and evaluation of future evidence-based wearable robotic exoskeleton–assisted walking programs offered in the community, and to initiate a reflection regarding the use of wearable robotic exoskeletons during initial rehabilitation following a spinal cord injury. CLINICALTRIAL ClinicalTrials.gov NCT03989752; https://clinicaltrials.gov/ct2/show/NCT03989752 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/19251

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Cardiorespiratory demand and rate of perceived exertion during overground walking with a robotic exoskeleton in long-term manual wheelchair users with chronic spinal cord injury: A cross-sectional study

Annals of Physical and Rehabilitation Medicine ◽

10.1016/j.rehab.2017.12.008 ◽

2018 ◽

Vol 61 (4) ◽

pp. 215-223 ◽

Cited By ~ 12

Author(s):

Manuel J. Escalona ◽

Rachel Brosseau ◽

Martin Vermette ◽

Alain Steve Comtois ◽

Cyril Duclos ◽

...

Keyword(s):

Perceived Exertion ◽

Cross Sectional Study ◽

Sectional Study ◽

Overground Walking ◽

Cross Sectional ◽

Wheelchair Users ◽

Robotic Exoskeleton ◽

Manual Wheelchair ◽

Cord Injury

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Effects of an Overground Walking Program With a Robotic Exoskeleton on Long-Term Manual Wheelchair Users With a Chronic Spinal Cord Injury: Protocol for a Self-Controlled Interventional Study

JMIR Research Protocols ◽

10.2196/19251 ◽

2020 ◽

Vol 9 (9) ◽

pp. e19251

Author(s):

Alec Bass ◽

Mylène Aubertin-Leheudre ◽

Claude Vincent ◽

Antony D Karelis ◽

Suzanne N Morin ◽

...

Keyword(s):

Physical Activity ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Sitting Time ◽

Chronic Spinal Cord Injury ◽

Wheelchair Users ◽

Robotic Exoskeleton ◽

Walking Program ◽

Cord Injury ◽

Regional Body Composition

Background In wheelchair users with a chronic spinal cord injury (WUSCI), prolonged nonactive sitting time and reduced physical activity—typically linked to this mode of mobility—contribute to the development or exacerbation of cardiorespiratory, musculoskeletal, and endocrine-metabolic health complications that are often linked to increased risks of chronic pain or psychological morbidity. Limited evidence suggests that engaging in a walking program with a wearable robotic exoskeleton may be a promising physical activity intervention to counter these detrimental health effects. Objective This study’s overall goals are as follows: (1) to determine the effects of a 16-week wearable robotic exoskeleton–assisted walking program on organic systems, functional capacities, and multifaceted psychosocial factors and (2) to determine self-reported satisfaction and perspectives with regard to the intervention and the device. Methods A total of 20 WUSCI, who have had their injuries for more than 18 months, will complete an overground wearable robotic exoskeleton–assisted walking program (34 sessions; 60 min/session) supervised by a physiotherapist over a 16-week period (one to three sessions/week). Data will be collected 1 month prior to the program, at the beginning, and at the end as well as 2 months after completing the program. Assessments will characterize sociodemographic characteristics; anthropometric parameters; sensorimotor impairments; pain; lower extremity range of motion and spasticity; wheelchair abilities; cardiorespiratory fitness; upper extremity strength; bone architecture and mineral density at the femur, tibia, and radius; total and regional body composition; health-related quality of life; and psychological health. Interviews and an online questionnaire will be conducted to measure users’ satisfaction levels and perspectives at the end of the program. Differences across measurement times will be verified using appropriate parametric or nonparametric analyses of variance for repeated measures. Results This study is currently underway with active recruitment in Montréal, Québec, Canada. Results are expected in the spring of 2021. Conclusions The results from this study will be essential to guide the development, implementation, and evaluation of future evidence-based wearable robotic exoskeleton–assisted walking programs offered in the community, and to initiate a reflection regarding the use of wearable robotic exoskeletons during initial rehabilitation following a spinal cord injury. Trial Registration ClinicalTrials.gov NCT03989752; https://clinicaltrials.gov/ct2/show/NCT03989752 International Registered Report Identifier (IRRID) DERR1-10.2196/19251

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Pain and its impact on functioning and disability in manual wheelchair users with spinal cord injury: a protocol for a mixed-methods study

BMJ Open ◽

10.1136/bmjopen-2020-044152 ◽

2021 ◽

Vol 11 (1) ◽

pp. e044152

Author(s):

Mokgadi Kholofelo Mashola ◽

Elzette Korkie ◽

Diphale Joyce Mothabeng

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

South African ◽

Phase 1 ◽

Pain Medication ◽

Self Management ◽

Medication Misuse ◽

Wheelchair Users ◽

Manual Wheelchair ◽

Cord Injury

IntroductionApproximately 80% of people with spinal cord injury experience clinically significant chronic pain. Pain (whether musculoskeletal or neuropathic) is consistently rated as one of the most difficult problems to manage and negatively affects the individual’s physical, psychological and social functioning and increases the risk of pain medication misuse and poor mental health. The aim of this study is to therefore determine the presence of pain and its impact on functioning and disability as well as to develop a framework for self-management of pain for South African manual wheelchair users with spinal cord injury.Methods and analysisCommunity-dwelling participants with spinal cord injury will be invited to participate in this three-phase study. Phase 1 will use a quantitative, correlational design to determine factors related to pain such as pectoralis minor length, scapular dyskinesis, wheelchair functioning, physical quality of life, community reintegration and pain medication misuse. Demographic determinants of pain such as age, gender, type of occupation, completeness of injury and neurological level of injury will also be investigated. Participants with pain identified in phase 1 will be invited to partake in a qualitative descriptive and contextually designed phase 2 to explore their lived experience of pain through in-depth interviews. The results of phases 1 and 2 will then be used with the assistance from experts to develop a framework for self-management of pain using a modified Delphi study. Data analysis will include descriptive and inferential statistics (quantitative data) and thematic content analysis (qualitative data).Ethics and disseminationApproval for this study is granted by the Faculty of Health Sciences Research Ethics Committee of the University of the Pretoria (approval number 125/2018). This study is registered with the South African National Health Research Database (reference GP201806005). This study’s findings will be shared in academic conferences and published in scientific peer-reviewed journals.

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